Trontell M C, Carson J L, Taragin M I, Duff A
Division of Pulmonary Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick.
J Gen Intern Med. 1991 Sep-Oct;6(5):445-9. doi: 10.1007/BF02598169.
To study the design, method of implementation, perceived benefits, and problems associated with a night float system.
Self-administered questionnaire completed by program directors, which included both structured and open-ended questions. The answers reflect resident and student opinions as well as those of the program directors, since program directors regularly obtain feedback from these groups.
SETTING/PARTICIPANTS: The 442 accredited internal medicine residency programs listed in the 1988-89 Directory of Graduate Medical Education Programs.
Of the 442 programs, 79% responded, and 30% had experience with a night float system. The most frequent methods for initiating a night float system included: decreasing elective time (42.3%), hiring more residents (26.9%), creating a non-teaching service (12.5%), and reallocating housestaff time (9.6%). Positive effects cited include decreased fatigue, improved housestaff morale, improved recruiting, and better attitude toward internal medicine training. The quality of medical care was considered the same or better by most programs using it. The most commonly cited problems were decreased continuity of care, inadequate teaching of the night float team, and miscommunication.
Residency programs using a night float system usually observe a positive effect on housestaff morale, recruitment, and working hours and no detrimental effect on the quality of patient care. Miscommunication and inadequate learning experience for the night float team are important potential problems. This survey suggests that the night float represents one solution to reducing resident working hours.
研究夜间轮值制度的设计、实施方法、感知到的益处以及相关问题。
由项目主任自行填写的问卷，其中包括结构化和开放式问题。答案反映了住院医师和学生的意见以及项目主任的意见，因为项目主任定期从这些群体中获得反馈。
地点/参与者：1988 - 1989年研究生医学教育项目名录中列出的442个经认可的内科住院医师培训项目。
在442个项目中，79%做出了回应，30%有夜间轮值制度的经验。启动夜间轮值制度最常见的方法包括：减少选修时间（42.3%）、雇佣更多住院医师（26.9%）、创建非教学服务（12.5%）以及重新分配住院医师时间（9.6%）。提到的积极影响包括疲劳减轻、住院医师士气提高、招聘情况改善以及对内科培训的态度更好。大多数使用该制度的项目认为医疗质量相同或更好。最常提到的问题是护理连续性降低、夜间轮值团队教学不足以及沟通不畅。
采用夜间轮值制度的住院医师培训项目通常会观察到住院医师士气、招聘和工作时间方面的积极影响，且对患者护理质量没有不利影响。沟通不畅和夜间轮值团队学习经验不足是重要的潜在问题。这项调查表明夜间轮值是减少住院医师工作时间的一种解决方案。
